Hi everyone,Can someone explain the liver flap symptom. Not the clinical definition, I would like to know what it looks like from anyone who has seen it. Is it a big movement like a bird flapping or what?

Do they do the test with arms in front of the body or out to the sides? I don't get it.

Hello Lauralai and welcome to HealingWell. Each time my husband went to his hepatologist they had him hold his arms out to the sides. As his disease progressed so did the movement of his hands/arms in an up and down direction. ( The flapping.) He could not hold them still. Thinking about it now........ and I really don't know for sure....but it may have something with muscle wasting. They probably could tell by how much movement as to how progressed the muscle wasting was getting. If someone knows for sure as to what the flapping test is for please jump in and let us know.

Take care........thoughts and prayers..........Pink GrandmaForum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.

Hi Laura and welcome to HealingWell. I am so sorry that you are going thru this. Your question is a good one and very understandable that you'd want to know. Asterixis (arm flapping) is caused from liver disease which causes muscle wasting. Doctors test for it basically by having the patient put their arms straight out and ask them to flex (bend) their wrist with fingers in an upward position so it looks like they are trying to stop traffic. Then they are asked to hold that position for a few minutes. Because the muscle can no longer support the weight of the arm it starts to flap almost immediately. This test is done to evaluate the degree of wasting. I also read your earlier post and want to agree that it could be bleeding ulcers caused by alcohol and it could also be varices. Either way it is serious as both conditions can end up in profuse bleeding or also called hemorrhaging.Black tarry stools are are indicative of a GI bleed most commonly caused by bleeding ulcers. Every time he consumes alcohol he is irriating the already damaged tissue so he'll bleed more. I would agree 100% with you. Your main objective is to be informed as well as take care of your babies. We are all here for you. I hope this has helped you some. Shelly

“Life is not the way it's supposed to be. It's the way it is. The way you cope with it is what makes the difference."

Shelly, I consulted Dr. Melissa Palmer's book on Hepatitis and Liver Disease regarding the asterixis. She states the test for it is to determine encephalopathy, but doesn't mention muscle wasting. Do they generally go hand-in-hand?

The muscle wasting is a part of the encephalopathy process but can occur with severe pulmonary and renal disease etc. It's not solely associated with liver issues however liver disease is the most common cause. There are so many symptoms involved that most people can't sort it all out. The muscle wasting and asterixis occurs in end stage usually. The legs can also have the flapping effect but normally family and friends notice it with the arms first. With all the issues, like proteins etc. the muscles deteriorate fairly rapidly. But you are correct it is a symptom of encephalopathy. I hope in trying to explain it in laymans terms that I didn't cause confusion. Without muscle we can't support our skeletal structure so muscle wasting is monitored closely. The actual flapping is a form of tremors that are an involuntary response when the arms are held out with the wrists bent palm out. With Lauras husbands behavior. symptoms, and continued drinking habits he probably has advanced liver disease but only his Dr can confirm that.

Shelly

“Life is not the way it's supposed to be. It's the way it is. The way you cope with it is what makes the difference."

Oh and I probably should add that I had him do this when he got home and his hands and wrists immediately started to quiver. It wasn't a big movement but it was noticeable so I'm wondering if that was the flapping? I tried it myself and no shaking, just so I could compare. His hands always seem shaky these days. In fact it's kinda weird because when I stand next to him his whole body seems like it's shaking sometimes. He seems really frail.

He's having a nose bleed at the moment and is pale compared to a few hours ago he looked sunburned, but with a deeper color if that makes sense? He's on his 4th beer since he got home. He looks kind of yellowish too. My children had jaundice after they were born and they were pretty yellow. He doesn't look like that so it's hard to tell. It's frustrating because it would be nice to hear what a doctor had to say, but he has no intention of going to one at this point.

An alcoholic w/o alcohol will start shaking (delirium tremors.) This is often associated with hallucinations. The facial redness is an inflammatory response from his liver--once again from alcohol. Many of his symptoms would clear up or diminish if he stopped drinking. It's doubtful he could stop on his own. He would likely need to be in a 30-day detox facility where medication such as Xanax is given to control the worst symptoms of withdrawal. They have AA meetings at inpatient facilities, but they would need to be continued once he got out in order to sustain his sobriety. It may take a drastic physical symptom for him to admit he needs help...if he ever does. (I'm an alcoholic who has been sober nearly 23 yrs.)